One of the most serious concerns for diabetics involves care of the feet. Diabetics must always be protective of their feet. Taking good care of the feet involves several factors. The first is closely monitoring glucose levels, and maintaining good control. A second factor involves physically taking good care of the feet themselves, through a regular routine of cleaning, inspection, protecting, and wearing good-fitting shoes on the feet.
Upon initial diagnosis of diabetes, one of the first things the patient is instructed to do is consult with a podiatrist to have the feet thoroughly examined. The podiatrist will normally inspect the feet, looking for potentially dangerous pressure points on the sides and bottoms of the feet -- checking the toenails for nail fungus, and looking for the effects of ill-fitting shoes. The podiatrist will also instruct the diabetic patient on how to check the feet daily. He will also show you how you can use a mirror to look at your feet and what to look for.
If your regular physician recommends it, your podiatrist can also prescribe a special "diabetic shoe" for you to wear.
When prescribing diabetic shoes, the podiatrist will take an impression of each foot. The impression is taken by forming a mold of the foot while placed in a dry substance that resembles styrofoam and forms an imprint of your foot. The podiatrist will use these impressions to make shoe inserts that actually follow the contour of your feet. Your feet will then be measured, and shoes will be ordered based on the measurements taken. Diabetic shoes are actually built with more room inside, to accommodate the insert and the foot. Wearing this insert in your special diabetic shoes should relieve the pressure points on the feet thus protecting the foot from trauma.
Your podiatrist will talk to you about precautions such as not walking around barefoot, wearing special protective socks on the feet, and being cautious when cutting the toenails or manicuring the feet.
The podiatrist will also explain that relieving pressure is important, because some diabetics lose their ability to feel pain in the extremities, as a result of poor circulation or diabetic neuropathy (nerve damage). This high pain threshhold can cause an injury to become more severe and affect the deeper layers of the skin, leading to further trauma, and possibly gangrene.
For example while walking around barefoot, a diabetic can sustain a cut or scrape on the bottom of the foot and never realize it because of lack of feeling. The cut or scrape can then become infected and advance to the point of becoming incurable or irreversible before the diabetic realizes it is developing.
Gangrene then can lead to complete loss of a foot or an entire limb. You don't want this to happen.
I have an elderly friend who tried to relieve her cold feet by putting her socks in the microwave oven to warm them up. She immediately put the microwaved socks on one of her feet, however because of nerve damage to her feet, she did not realize the sock was burning her right foot. She ended up having to go to the doctor with the burn. She had sustained 3rd degree burns as a result of doing this. Within a matter of months, she had lost the leg up to her knee. She now has to wear a prosthetic device and is confined to a wheel chair most of the time.
Early after my diagnosis, I was fitted for diabetic shoes, however, I found them to be awkward. I felt like I was walking on platforms and was very unsteady in my gait. Therefore, I do not wear my diabetic shoes very much.
But, I have found some alternatives to wearing diabetic shoes that are comfortable, and do not bother my feet. And I have learned how to evaluate my shoes in terms of how they feel on my feet, and my comfort level when walking in them.
One rule of thumb I follow is that I do not buy any shoe that does not feel totally luxurious on my feet out of the box. If it eats my toes, I don't buy it. If it feels too tight around my foot, I don't buy it. If my toes burn in the shoe, I don't buy it. I just don't.
If a shoes causes me any discomfort, or causes me difficulty walking, I do not buy it. Often, finding the right shoes means all-day shopping trips - sometimes out-of-town, and lengthy online shopping sessions. But, in the long run, I know my feet will thank me for the care and caution I use in selecting shoes.
Here are some common recommendations offered to diabetics for the care of the feet: use a mild soap to wash the feet in luke warm water every day; gently dry the feet with a soft cloth; apply oil or cream to the feet to remove scaly skin; before putting on shoes and socks dust the feet with non-medicated powder; cut toe nails carefully straight across to avoid ingrown toe nails; always wear socks; never attempt to treat corns or calluses on the feet consult your podiatrist instead; avoid smoking; and finally, never walk bare-foot.
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